1
Improve Knowledge Transfer and Sharing Practices
among Service-providers In the Context of E-health:
A Case Study of U-CARE Community
Yi Sun
Department of Informatics and Media
Master in Information Systems
Uppsala University
Uppsala
Sweden
29
thAugust 2013
ABSTRACT
As more and more convenience technology brings to human’s life by breaking through the obstacles of geography and psychology, e-health is being accepted by increasing number of people.
It shows great potential to decrease the gap between the needs and satisfaction. However, the potential of e-health is far from being noticed. Knowledge shows inevitable advantages in different domains and of course the same in the health care industry. There are many different aspects that can be investigated and improved to reach the purpose, but in this dissertation, we aims to explore how to achieve a better knowledge transfer and sharing among e-health service-providers in order to create high-quality services that will be delivered to the patients. In general, U-CARE community is the one case that studied in this dissertation to explore how to identify knowledge transfer & sharing practices and what techniques can be used to improve it in the context of e-health. A theoretical framework from Etienne Wenger is applied here to help the author understand community well. Further analysis and discussion are based both on existing theories derived from literature review and empirical data obtained in interviews. The main contribution from the author and conclusion in this dissertation are summarized in a format of framework concerning useful techniques and methods (shown in Figure 9), which involves knowledge transfer and sharing practices related to formal/informal meetings, face-to-face communication, coordinator, online platform, IT tools, change management, documentation management, tracking of requirements & decisions, library of FAQ and personalization. The transferred and shared knowledge investigated in this dissertation is “back-office” data, not directly related to patient data, so the protection of patient personal privacy is not a consideration in this dissertation.
Keywords: e-health, knowledge management, knowledge sharing, knowledge transfer
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ACKNOWLEDGEMENTS
Writing this dissertation has been a precious and unique experience, which enlightens and teaches me a lot. Especially, it cannot be fulfilled without the support and encouragement from teachers and U-Care community.
First of all, I am utterly grateful for the patient guidance and enthusiastic encouragement from my supervisor, Jonas Sjöström. During the whole process of writing this dissertation, he gave me many insightful comments and constant support. Every time when I came across problems regarding theory or methodology, he gave me his profound experience and guidance generously.
So the completion of this dissertation has been indispensable with efforts and time from my supervisor.
My grateful thanks are also extended to all the staff in U-CARE community for their assistance with the collection of my empirical data. Thanks for Helena Grönqvist, the coordinator in U-CARE community, to give me utter welcome and support to do investigation on U-CARE and help me find suitable interviewees in the interviews. Thanks for all the staff involved in the interviews to give me their great efforts and support for data collection.
I would also like to express my appreciation to Steve Mckeever, the responsible teacher in the course of Thesis Project, for giving us lectures regarding some guidance in thesis writing and application of different tools and practical methodology.
Last but not least, I would like to thank my family and friends to stand behind me and give me great support and understanding as usual, which helped me release the pressure and encouraged me to work forward. This is the indispensable motivation for me to overcome all the difficulties and work hard.
LIST OF TABLES
TABLE 1:DEFINITION OF KNOWLEDGE MANAGEMENT (SOURCE:NEVO AND CHAN,2007) 11
TABLE 2:COMPARISON OF THREE BASIC RESEARCH DESIGNS 17
TABLE 3:KNOWLEDGE SOURCES IN HEALTH CARE (SOURCE:BOSE,2003) 24
TABLE 4:SUMMARY OF RELATED STUDIES (SOURCE:PENTLAND D. ET AL,2011) 27
TABLE 5:REFERENCE OF INTERVIEW QUESTIONS 39
TABLE 6:TRACK REQUIREMENTS 49
LIST OF FIGURES
FIGURE 1:THE KNOWLEDGE MANAGEMENT CYCLE (SOURCE:BOSE,2003) 11
FIGURE 2:FRAMEWORK FOR RESEARCH DESIGN (SOURCE:COLIN ROBSON,2002) 17 FIGURE 3:TACIT AND EXPLICIT KNOWLEDGE IN THE WORKPLACE (SOURCE:SMITH,2001) 25 FIGURE 4:AN INTEGRATIVE FRAMEWORK: FACTORS INFLUENCING EFFECTIVE KNOWLEDGE TRANSFER (SOURCE:GOH SC.
2002) 28
FIGURE 5:A MODEL OF KNOWLEDGE SHARING BETWEEN INDIVIDUALS IN ORGANIZATIONS 29 FIGURE 6:STRUCTURAL ELEMENTS OF A COMMUNITY OF PRACTICE (SOURCE:SNYDER AND DE SOUZA BRIGGS,2004) 32 FIGURE 7:ORGANIZATION OF U-CARE(SOURCE: HTTP://WWW.U-CARE.UU.SE/ABOUT-U-CARE/ORGANIZATION/) 37
FIGURE 8:COMPONENT OF THE WORKGROUP IN U-CARE 38
FIGURE 9:FRAMEWORK FOR KNOWLEDGE TRANSFER AND SHARING IN THE CONTEXT OF E-HEALTH 50
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CONTENT
1. INTRODUCTION 7
1.1BACKGROUND 7
1.1.1 E-health defined 7
1.1.2 Current e-health development 9
1.1.3 Knowledge management 9
1.2PROBLEM DISCUSSION 12
1.3RESEARCH QUESTION 14
1.4PURPOSE 14
1.5INTERESTED STAKEHOLDERS 14
1.6DELIMITATION 14
1.7DISSERTATION OUTLINE 15
2. RESEARCH METHODOLOGY 16
2.1OVERVIEW OF RESEARCH APPROACH 16
2.2RESEARCH DESIGN 16
2.3QUALITATIVE AND QUANTITATIVE METHODOLOGIES 18
2.4RESEARCH STRATEGY 18
2.5DATA COLLECTION 19
2.5.1 Literature review 19
2.5.2 Interview 19
2.6SELECTION OF RESPONDENTS 21
2.7TRANSCRIPTION OF THE INTERVIEW 22
2.8RELIABILITY AND VALIDITY OF THE RESEARCH 22
3. LITERATURE REVIEW 24
3.1CONCEPT AND THEORIES 24
3.1.1 Different types of knowledge 24
3.1.2 Key characteristics of knowledge transfer and sharing in health care industry 25
3.2EXISTING KNOWLEDGE SHARING AND TRANSFER FRAMEWORKS 28
3.2.1 Framework 1 28
3.2.2 Framework 2 29
3.3THEORETICAL FRAMEWORK IN CASE STUDY 30
3.3.1 Framework applied in case study 30
3.3.2 Why we selected this framework 30
3.3.3 Alternatives to Wenger’s framework 31
3.4SUMMARY OF THE LITERATURE REVIEW 33
4. CASE STUDY 34
4.1INTRODUCTION TO THE STRUCTURE OF CASE STUDY REPORT 34
4.2CASE STUDY REPORT 35
4.2.1 Focus of the case study 35
4.2.2 Background 35
4.2.3 Brief Description of data collected 38
4.2.4 Methodology 38
5. ANALYSIS AND DISCUSSION 41
5.1EMPIRICAL FINDINGS 41
5.1.1 The role of interviewee 41
5.1.2 Interactions between roles: activities & tools 42
5.1.3 Interactions with outside world 43
5.1.4 Resources & constraints 43
5.1.5 Acceptance for change 44
5.1.6 Acceptance for technology boundaries 44
5.1.7 More needs 44
5.2PREREQUISITES FOR KNOWLEDGE TRANSFER AND SHARING 44
5.3TECHNIQUES AND METHODS CAN BE USED TO IMPROVE KNOWLEDGE TRANSFER AND SHARING PRACTICES IN
U-CARE 46
5.3.1 Change management 46
5.3.2 Documentation management 47
5.3.3 Track requirements and decisions 48
5.3.4 Library of Frequently Asked Questions for staff 49
5.3.5 Personalization 49
5.4SUMMARY OF ANALYSIS AND DISCUSSION 49
6. CONCLUSION 51
6.1ANSWERS FOR RESEARCH QUESTIONS 51
6.2IMPLICATION FOR THEORY 52
6.3IMPLICATION FOR PRACTICE 52
6.4FURTHER WORK 53
REFERENCES 54
APPENDIX 59
APPENDIX A:LETTER TO THE COORDINATOR OF U-CARE 59
APPENDIX B:FRAMEWORK FROM WENGER (WENGER,E.C.,WHITE,N.,SMITH,J.D.,2009) 61
APPENDIX C:INTERVIEW QUESTIONS CHECKLIST 72
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1. Introduction
The first chapter in this dissertation introduces the historical context in which this study is engaged and objectives of this study. Background is provided to explain the research domain and demonstrate knowledge of the main concepts and related ideas. The following problem discussion part displays the motivation for choosing and conducting this research. This part is followed by the presentation of specific research questions, purpose, interested stakeholders and the delimitation of this dissertation as well. At the end of this chapter, an overview of this dissertation is introduced.
1.1 Background
The emergence of internet and many electronic technologies definitely changes the way of people’s living. People can use e-commerce instead of going to a specific shop to purchase and people can use e-learning instead of attending a class in a specific classroom. Meanwhile, people can use e-health to receive treatment from doctors and health staff instead of going to an exact hospital. As more and more convenience technology brings to human’s life by breaking through the obstacles of geography and psychology, e-health is being accepted by increasing number of people gradually. It provides people with chances for better access to therapeutic interventions which have easy engagement and low threshold requirement (Copeland and Martin, 2004;
Humphreys and Tucker, 2002). And some studies claim that many people prefer the internet over face-to-face services; they answer questions more sincerely and feel more comfortable in the internet setting (Cook and Doyle 2002; Farrell and McKinnon 2003; Griffiths et al.2006; Richards 2009). Thereby, facing with the increasing huge demands for health care, e-health shows great potential to decrease the gap between the needs and satisfaction.
But, the potential of e-health is far from being mined. In e-health, patients receive the health care services created by e-health staff by means of internet or other related electronic technologies.
Thereby, quality of information delivered from the e-health staff will directly influence the quality of health care services received by patients. Since the quality of delivered information has been put into the spotlight, it is also catching the attention that how to increase the quality of the health service created by e-health staff. Of course, there are many different aspects that can be investigated and improved to reach the target. But in this dissertation, we aims to explore how to achieve a better knowledge transfer and sharing among the e-health staff to avoid knowledge loss in order to create high-quality services that will be delivered to the patients.
1.1.1 E-health defined
There are various terms that are roughly interchangeable with e-health, such as health informatics, telemedicine, telehealth, or health telematics, medical informatics. To some extent, these terms can reveal the historical development of e-health and the role of technology over time in this process.
The term “medical informatics” is used around 1970 to refer to the processing of medical
information by computers (International Telecommunication Union, 2012). But soon this kind of
“information processing” is replaced by “information communication” due to the rapid development and spread of internet. And “medical informatics” is also evolved to “health telematics” or “telemedicine” until to today’s “e-health” (International Telecommunication Union, 2012) in which the prefix “e-” may emphasize the involvement of the internet.
There are more than 50 definitions of e-health. Some scholars regarded this definition as the most suitable one as it emphasizes the role the internet played in e-health (Jung M.L, 2008; Pagliari, 2005): “The use of emerging information and communication technology, especially the Internet, to improve or enable health and health care.” Another definition is regarded as an excellent one (European Integration, 2002; Mossialos et al., 1999): “ a means of applying new low cost electronic technologies, such as ‘web enabled’ transactions, advanced networks and new design approaches, to healthcare delivery. In practice, it implies not only the application of new technologies, but also a fundamental re-thinking of healthcare processes based on using electronic communication and computer-based support at all levels and for all functions both within the healthcare service itself and in its dealings with outside suppliers. E-health is a term which implies a way of working rather than a specific technology of application.” And the most quoted one among all the different definitions is (Curtis, 2007; Eysenbach G, 2001): “ e-health is an emerging field in the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the Internet and related technologies. In a broader sense, the term characterizes not only a technical development, but also a state-of-mind, a way of thinking, an attitude, and a commitment for networked, global thinking, to improve health care locally, regionally, and worldwide by using information and communication technology.” It is difficult to decide which definition is the best one but it is not difficult to figure out that the central points in the definition are all related to technology and health care. This is also disclosing the two objectives of e-health. One is to provide the necessary health treatment to the web-based patients.
The other objective is to make the interactive communication possible and efficient between the health care staff and the patients through the IT tools.
According to Broderick and Smaltz’s study (2003), there are several dimensions of e-health from which an overall description of e-health’s related work and function:
1. Delivery of key information to healthcare partners;
2. Provision of health information delivery services;
3. Facilitation of interaction between providers and patients;
4. Facilitation of interaction of healthcare industry-related business processes;
5. Both local and remote access to healthcare information;
6. Support for employers and employees, payers and providers.
When it comes down to this dissertation, it mainly aims to enhance the second dimension which is
“Provision of health information delivery services”. It aims to present how to develop good knowledge sharing and transfer practices to improve the quality of health information provision.
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1.1.2 Current e-health development
Between the year 1998 and 2002, the amount of adults who had used internet for health information increased from 54 million to 110 million (Taylor and Interactive, 2002). According to some studies from 2004 to 2006(3-6), it has found that between 56% and 79% of internet users in US chose to obtain health information online. Additionally, an eight researchers’ study in 2007 which investigated European citizens’ use of e-health services (Andreassen et al., 2007) showed that 44% of the total sample which is consisted of 7934 respondents from seven European countries (Norway, Denmark, Germany, Greece, Poland, Portugal and Latvia), 71% of internet users, had used the internet for health information services. Comparatively, women were the most active users for health purpose among internet users. Even though the demands from the internet users for health purpose are increasing, e-health shows great advantage to fill up this gap between the demands and the satisfaction.
Basically, the rapid development of e-health can attribute to several aspects. Obviously, the first reason should be the explosive growth of the internet use over the years. As an efficient medium for spreading or gathering information, it not only made full use of computer and other telecommunications, but also made the interactive communication between remote distances possible. At the same time, more investment is put into the technical infrastructure for health care to overcome the coming challenges related to health care and finance (Broderick and Smaltz, 2003). Last but not least, the development of wireless technology should be another reason attributed to, which enables internet users to have easy access to the internet no matter where they are.
Inevitably, e-health is facing challenges during the development process as well. E-health programs are implemented in 53 Commonwealth countries, but a report to Commonwealth Secretariat (Seabrook W. and Ruck A., 2008) pointed out that there are few mechanisms in place to support:
Coordination of existing e-health initiatives across the Commonwealth;
Fostering of alignment between Commonwealth e-health initiatives and e-health initiatives supported by other international bodies or countries;
Coordination of e-health policy at both a regional and global level;
Facilitation of communication on e-health at the regional and global level;
Building on best practices in e-health used successfully in one country and extend them to other countries;
Coordination of the private sector to realize efficiencies of scale and help to ensure sustainability;
Building on existing initiatives and infrastructure;
Developing regional access to required testing and diagnostic tools.
1.1.3 Knowledge management
There is never lack of research related to knowledge since knowledge has long been regarded as
crucial organizational resources and its effective management is increasingly considered as a good way to increase competitiveness to achieve success (Egbu, 2000; Nevo and Chan, 2007). But to the organization, there is still lack of awareness and understanding related to knowledge management which is shown according to the interviews in the case study part of this dissertation, so even not the effective management. It is necessary to state the definition of knowledge management. It also evolves over time which enables to reveal the change of focus on knowledge manage study. The following table is a review of different Knowledge Management’s definitions from Nevo and Chan’s study (Nevo and Chan, 2007).
2006 ‘‘Knowledge management addresses policies, strategies, and techniques aimed at supporting an organization’s competitiveness by optimizing the conditions needed for efficiency improvement, innovation, and collaboration among employees.’’ (C.A.A Sousa et.al. 2006)
2005 ‘‘KM is defined as doing what is needed to get the most out of knowledge resources.’’ (R.Sabherwal et.al.
2005)
2003 ‘‘Knowledge management is defined as the organized and systematic process of generating and disseminating information, and selecting, distilling, and deploying explicit and tacit knowledge to create unique value that can be used to achieve a competitive advantage in the marketplace by an organization.’’
(G.T.M Hult, 2003)
2003 ‘‘Knowledge management may be defined as doing what is needed to get the most out of knowledge resources. Knowledge management focuses on organizing and making available important knowledge, wherever and whenever it is needed.’’ (R.Sabherwal et.al. 2003)
2003 ‘‘Knowledge management concerns an organization’s ability to develop and utilize a base of intellectual assets in ways that impact the achievement of strategic goals.’’ (N.A. Morgan et.al. 2003)
2003 ‘‘We can conceptualize knowledge management as a process whose input is the individual knowledge of a person, which is created, transferred and integrated in work teams within the company, while its output is organizational knowledge, a source of competitive advantage.’’ (C.Zarraga et.al. 2003)
2001 ‘‘Knowledge management refers to identifying and leveraging the collective knowledge in an organization to help the organization compete. . . . ‘‘Knowledge management is largely regarded as a process involving various activities . . . At a minimum, one considers the four basic processes of creating, storing/retrieving, transferring, and applying knowledge.’’ (M.Alavi et.al. 2001)
1999 ‘‘Knowledge management is the formal management of knowledge for facilitating creation, access, and reuse of knowledge, typically using advanced technology.’’ (D.O’Leary, 1999)
1999 ‘‘Knowledge Management is a business process. It is the process through which firms create and use their institutional or collective knowledge. It includes three sub-processes: Organizational learning—the process through which the firm acquires information and/or knowledge Knowledge production—the process that transforms and integrates raw information into knowledge which in turn is useful to solve business problems Knowledge distribution—the process that allows members of the organization to access and use the collective knowledge of the firm.’’ (M.Sarvary, 1999)
1999 ‘‘Managing knowledge is a multidimensional process. It requires the effective concurrent management of four domains: content, culture, process, and infrastructure.’’ (L.P.Chait, 1999)
1998 ‘‘[a] term which has now come to be used to describe everything from organizational learning efforts to database management tools.’’ (R.Ruggles, 1998)
1996 ‘‘[t]he management of knowledge goes far beyond the storage and manipulation of data, or even of information. It is the attempt to recognize what is essentially a human asset buried in the minds of
11 individuals, and leverage it into an organizational asset that can be accessed and used by a broader set of individuals on whose decisions the firm depends.’’ (R.Maier, 2004)
1994 ‘‘In its broadest sense, knowledge management (KM) is a conceptual framework that encompasses all activities and perspectives required to making the organization intelligent-acting on a sustained basis. KM includes activities to gaining overview of, dealing with, and benefiting from the areas that require management attention by identifying salient alternatives, suggesting methods for dealing with them, and conducting activities to achieve desired results.’’ (K.M.Wiig, 1994)
Table 1: Definition of knowledge management (source: Nevo and Chan, 2007)
To summarize, knowledge management is an organizational process by which knowledge will be created, captured, acquired, structured, transferred and applied effectively to support organization goals (Egbu and Botterill, 2002). Basically, knowledge is an abstract word which may have different meanings in different contexts. In an organization, knowledge is regarded as the professional intellect such as “know-what, know-how, know-why, self-motivated creativity, best practices, concepts, values, beliefs and method of working that can be shared and communicated”(Bose, 2003).
According to Ranjit Bose’s study (Bose, 2003), knowledge management cycle is composed of four processes that are knowledge creation, knowledge structuring, knowledge dissemination and knowledge application. The figure is provided below.
Figure 1: The knowledge management cycle (source: Bose, 2003)
The process that is mainly investigated in this dissertation is knowledge dissemination. It is mostly related to improve the knowledge sharing and transfer practices among staff in the e-health organization in order to create high-quality e-health service to e-health users.
There is some discussion between the two terms: information and knowledge. In this regard, the accumulation of the organized facts or data which has a meaningful context is information (Egbu, 2000; Bose, 2003). And knowledge is on a higher level of understanding than information.
According to Egbu’s study (2000), on the basis of information, knowledge is composed of truths, beliefs, perspectives, judgments, methodologies and exists in different forms. For Sanchez et al’s point of view, knowledge is not only the certain and independent neural process of thinking or understanding regarding one phenomenon, but a set of beliefs based on the selectivity and judgment on causal relationship between phenomena. Namely, organizational knowledge is a set of shared beliefs about causal relationships that may be held in different individuals in an organization (Egbu and Botterill, 2002). In Ranjit Bose’s study, it is pointed out that the well structured and managed information that is available to the right people and processed at the right time becomes knowledge (Bose, 2003). From the above, it is not difficult to figure out that knowledge is another more meaningful and active existence of information and knowledge adds more people’s value to data and information.
1.2 Problem discussion
As more and more people realize that the first wealth is health and health care becomes a most concerning topic among people, e-health has gained increasing amount of attention which enables internet users to have easier access to health care services. The ability and potential of e-health to satisfy increasing needs of health care services and to fill up the gap between the demands and satisfaction could not be ignored. E-health becomes an important supplement in health care industry. And the potential of e-health is far from what is recognized.
The organizational intangible assets are considered as significant factors in developing competitiveness (Egbu, 2000; Edvinsson, 2000). As an important component of intangible assets in an organization, the development and effective management of knowledge should be taken into consideration. Different organizations in different domains have realized that knowledge management should be the primary step of effective management in development in the future and also put knowledge at the centre of the organization (Nevo and Chan, 2007). At the early stage of research in knowledge management theory, the emphasis is mainly on IT tools, methodologies and roadmaps, but now the focus is shifted to the view of “human-centered” knowledge management (Antonova and Gourova, 2006). That is, as the unique holders of knowledge, people are considered to play an important role during the process of knowledge management especially the knowledge exchange between people. The knowledge networks and working groups can support the sharing and transfer of knowledge well and can motivate the generation of new knowledge and ideas (Antonova and Gourova, 2006). This is also the motivation of this dissertation to put research focus on analyzing the knowledge sharing and transfer among staff in the organization.
13 Knowledge shows inevitable advantages in different domains and of course the same in the health care industry. To some extent, the quality of health care is decided by the quality of knowledge management practice within the community or across the organizational boundaries (Jadad et al., 2000). One challenge that health care practitioners are facing now is how to make effective decisions via the available information at hand (Bali et al., 2011). It is challenging because the condition of overload information in the organization. So the effective and right decision is influenced by the effective delivery of information and effective transfer of information and knowledge. It is necessary for health care practitioners to know how to make the best knowledge sharing and transfer in the context of an organization. Especially in the industry of e-health which mainly depends on the on-line information to deliver to the patients, it is even more important to make better knowledge sharing among experts in order to get better health care outcomes. Most of the internet user, who have different roles, education levels, backgrounds, can encounter the anxiety because of the poor organized and available knowledge online. And the poor knowledge management practice can also result in the conflicts during the process of making decisions or offering health treatment if decision makers can not have the accurate and consistent information available at the same time (Jadad et al., 2000). But health care systems don’t have adequate mechanisms to support knowledge sharing and transfer practices (Greiner and Knebel, 2003).
There is a demand to analyze and develop some mechanism or framework to support better knowledge sharing and transfer practices.
Now, e-health is a program supported by the Commonwealth Secretariat which is developed to support the development of health systems. The Commonwealth is a worldwide voluntary association. It consists of 54 countries to support and cooperate with each other towards the common goals in development. And the Commonwealth Secretariat is the department to execute the plans from Commonwealth Heads of Government (Commonwealth Secretariat). According to the Commonwealth Health Ministers Meeting (CHMM) in 2008, there were some requirements that Secretariat was mandated to do:
Pursue high-level policy dialogues involving the health and information technology sectors, the private sector, health professionals and civil society on the opportunities and the challenges of e-health; they also requested the Secretariat to facilitate these dialogues;
Explore setting up e-health pilot projects in all regions of the Commonwealth;
Pursue public-private partnerships (PPPs) in e-health;
Share knowledge, expertise and technical assistance between Commonwealth countries, both North-South and south-south;
Leverage additional resources to support the further development of its work on e-health and development.
It is shown that the knowledge sharing and transfer could be the focus trend in the e-health development in the future. And to set up the whole knowledge sharing and transfer mechanism across countries is a big work and project, so starting to set up a solid mechanism in one community could be a starting point and good choice.
There are some studies have already conducted research on some strategy, framework or models of knowledge management on a high level (Holsapple & Joshi, 2002; Quinn et al., 1998;
Rubenstein-Montano et al., 2001). At the same time, there is a paucity of research and studies specifically in the field of knowledge transfer and sharing between individuals in organizations and empirical data has just begun to reveal some relationships in the complex process (Ipe M, 2003). This dissertation aims to mainly focus on knowledge sharing and transfer practices in the domain of knowledge management. And it will combine with an analysis of a specific e-health community to put forward some practical measures both from process and technology view and then summarize a whole framework in the context of e-health. So it can be general and also specific.
1.3 Research question
Consequently, the research questions that will be investigated in this dissertation are:
1) How to identify existing knowledge sharing and transfer practices in the context of e-health?
2) Identify and assess methods and techniques to achieve better knowledge sharing and transfer in an e-health community.
1.4 Purpose
The aim of this dissertation is to enhance interactive communication among e-health staff to achieve the best knowledge transfer and sharing practices within the e-health community. A case study is conducted. Some techniques are introduced both from the process view and practice view.
1.5 Interested stakeholders
All the research questions that will be investigated in this dissertation are all in the context of e-health and knowledge management, so the interested stakeholders could be:
Health care communities;
Academic institutions;
Health professionals and the associations;
Managers and staff in the health care community;
Students or scholars who are interested in e-health or knowledge sharing and transfer.
1.6 Delimitation
E-health contains many different technological tools and applications that can offer health care services to the e-health users, such as internet or telephones. But e-health discussed in this paper is just limited to internet-based health care treatment and other communication technologies are not discussed in this dissertation. The investigated range of knowledge sharing and transfer practice in the case study is limited to one-community-based organization in the e-health field. We didn’t take the problem of budget into our investigation in this dissertation. The transferred and shared knowledge which is discussed in this dissertation is “back-office” information and knowledge, not
15 directly related to patient data. So the protection of patient personal privacy is not a consideration in this dissertation.
1.7 Dissertation outline
Chapter one introduces the historical context in which this study is engaged and objectives of this study. It involves background, problem discussion, research questions, purpose, interested stakeholders and delimitation of this dissertation.
Chapter two offers an explanation and justification of research method used to collect research data and techniques to interpret and analyze the data.
Chapter three provides a summary of literature review. Firstly, some basic concepts and theories are provided. In the second section, a summary of existing knowledge transfer and sharing frameworks in previous literature is given. In the last section, we explain a framework that we chose to use in case study and introduce other three alternatives as well.
Chapter four presents some key aspects in the case study in a format of case study report. These aspects contain the focus, context of the case study, description of the data collected, credential of the investigator and methods used for the case study and trustworthiness.
Chapter five presents empirical findings and the results of analysis and discussion which are the main contribution of this dissertation. It is divided into four sections: (1) empirical findings are provided first according to the data from interview which is the foundation of all analysis and discussion; (2) prerequisites for knowledge transfer and sharing are discussed according to literature and empirical data; (3) techniques and methods are presented in order to improve knowledge transfer and sharing in U-CARE community; (4) the conclusions and results are summarized in a format of framework with specific techniques, which are the main contribution of this dissertation regarding how to achieve better knowledge transfer and sharing practices (as shown in Figure 9).
Chapter six concludes the analysis of the study and provides the answers to the research questions. Finally, summarizes the implications for both theory and practice and provided further work.
2. Research methodology
This chapter offers an explanation and justification of research method used to collect research data and techniques to interpret and analyze the data.
2.1 Overview of research approach
There are many alternative research approaches to guide researcher to achieve research purposes.
But the suitable research approach can lead the researchers to gain justifiable research results with respect to research questions and research purposes. So after the research questions and purpose being defined, the following significant step is to choose suitable research approach for this dissertation.
Actually, choice of research approaches to collect and interpret research data are all based on research questions and purpose. Since the emphasis in this dissertation is on identifying knowledge transfer and sharing practices in the e-health community and investigating how to improve corresponding practices to achieve better knowledge transfer and create high-quality e-health services, this dissertation is an exploratory study. Additionally, in the stage of investigating the practices in U-CARE community, a framework was used to describe the characteristics of the practices. So this dissertation is a descriptive study as well. Based on the research questions and purpose, the data needed in this dissertation are all non-numerical data, so qualitative methodology is applied in this dissertation. Because the focused investigated area (e-health) and target group (staff) are all fixed, case study is considered as the suitable research strategy in this dissertation chosen among different strategies in the domain of qualitative methodologies. The case study was conducted in U-CARE community, which is an e-health community located in Uppsala. In order to support our data analysis and discussion both from theoretical view and practical view, we collected data mainly through literature review and interview. Interviews were conducted among staff in the workgroup of U-CARE. Last, approach used for the transcription of the interviews is thematic coding approach, which analyzed empirical data according to different themes.
2.2 Research design
As Colin Robson writes in his book Real World Research (2002): “Design is concerned with turning research questions into projects”. A research design is an initiative scheme for collecting, interpreting and analyzing research data, and it depends on the purpose of the research and the strategies and tactics that you choose to conduct the research depend on the type of research questions you are coming up with (Robson, 2002; Cooper and Schindler, 2003). In one of Hakim’s (2000) several books that are focusing on research design issues, a comparison between designers of research projects and architects is made (Robson, 2002).
“Design deals primarily with aims, purpose, intentions and plans within the practical constraints of
17 location, time, money and availability of staff. It is also very much about style, the architect’s own preferences and ideas (whether innovative or solidly traditional) and the stylistic preferences of those who pay for the work and have to live with the final result”.
Regarding the models of research design, there are many created models. The framework of Colin Robson (2002) is introduced here:
Figure 2: Framework for research design (source: Colin Robson, 2002)
It is shown that all the aspects are interrelated to each other. The purpose of the research and the conceptual framework used in the dissertation can decide what kind of research questions should be defined. Once research questions are decided, you are able to specify the methods and sampling strategy that can be used in the research. As mentioned above, the research design is much more related to the research questions. Additionally, there are three basic types of research design:
exploratory design, descriptive design and causal design. Thus referring to each research design’s characteristics, it is easier to decide which design is suitable for the dissertation. A comparison among these three research design is shown in Table 2:
Exploratory Descriptive Causal
Objective Discovery of ideas and insights
Describe characteristics or functions
Determine cause and effect relationships Characteristics Flexible, versatile;
often the front, end of total research design
Marked by the prior formulation of specific hypotheses;
preplanned and structured design
Manipulation of one or more independent variables; control of other mediating variables
Methods Expert surveys Pilot surveys Secondary data Qualitative research
Secondary data Surveys Panels
Observation and other data
Experiments
Table 2: Comparison of three basic research designs
When it comes down to this dissertation, the purpose of this paper is mainly trying to explore ideas and insights regarding methods or techniques that can be used to improve knowledge sharing and transfer practice in e-health industry. Yet in the stage of investigation into U-Care community,
Purpose(s) Conceptual
framework
Sampling strategy Methods
Research questions
a framework is used first to identify and describe the existing characteristics of practices in the U-Care community. Referring to Table 2, it is easy to figure out that exploratory research design and descriptive research design are used in this study.
2.3 Qualitative and quantitative methodologies
Basically, there is a basic decision should be made when conduct a social research: which research approach should be applied (Robson, 2002). The two alternatives of research approach that are clarified in social research industry are quantitative and qualitative research (Robson, 2002).
According to Colin Robson (2002), the research route in so-called “natural” science is almost quantitative approach, such as physics, chemistry and biology, which is mainly focusing on the data in the numerical or statistical form to figure out the relationship between different variables.
Contrarily, the advocates of qualitative approach asserted that, different from natural science, social science emphasizes on human beings, including language, consciousness and interactions between people which are in the verbal or non-numerical form (Robson, 2002). Because qualitative data is concerned with words, description or narratives, it is collected through unstructured interviews or observation (Hair et al., 2007).
Regarding this dissertation, qualitative approach is much more suitable than quantitative approach.
Firstly, the purpose of this dissertation is to identify the knowledge sharing and transfer practice in a community and then investigate how to make improvements. So the necessary data that need to be collected and analyzed in this dissertation is the information regarding the current existing practices regarding knowledge sharing and transfer. They were all collected through semi-structured interviews among staff in the U-Care community. All the following analysis and discussion phases are based on the collected data. These collected data are all qualitative data. And this choice is also matching the characteristic of exploratory research design which commonly exists in qualitative research.
2.4 Research strategy
Research strategy represents different ways of collecting and analyzing empirical evidence (Robson, 2002). Research strategies contain experiments, surveys, case studies, history and archival analysis (Yin, 1994). According to Colin’s study (2002), the typical features of case study are:
Selection of a single case (or several related cases) in a specific context;
investigation of the case in its context;
Collection of information via data collection methods such as interviews, observation or documentation analysis.
Because the investigated industry (e-health) and target interview group (staff) are all fixed, case study is supposed to be the suitable research strategy to get detailed and intensive knowledge in a single case (Robson, 2002).
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2.5 Data collection
The data needed in this dissertation is mainly to support the data analysis and discussion both from the theoretical view and practical view. So the approaches used for theoretical and empirical data collection in this dissertation are literature review and interview.
2.5.1 Literature review
A very important part of qualitative data in the research that can be used to support opinions and ideas is the existing study or research. Of course, literature can provide key concepts’
interpretation and solid theoretical background as pillars of the dissertation. Literature review is the process of reading, understanding and collecting knowledge and views related to your research field. An excellent and effective literature review can set up the foundation for advancing knowledge (Webster and Watson, 2002). It can collaborate with different wisdoms to get in-depth knowledge for each specific topic and analyze the question by different opinions from different angles. Last but not least, literature exposes the gaps and uncertainty in knowledge and dispute areas which can be a guide or direction for the motivation of the dissertation or further work (Robson, 2002). The documents that can be reviewed are articles, books, journals, dissertations, electronic media, etc.
Before start to search for the literature, it is important to choose the accurate key words to search the literature. This can be achieved by checking the dissertation’s purpose and research question.
So through checking the purpose and research questions in this dissertation, the chosen key words to search for literature are: e-health, knowledge management, knowledge sharing and knowledge transfer.
Regarding the searching process of literature, there are mainly three means offering literature assets: library, electronic databases and search engines. These three means were all used in this dissertation. Owning a library card, it is convenient to borrow books or journals in university or other academic libraries in Sweden. And the key words are also applicable in the search engine in the library. The electronic databases and search engines used in this dissertation are Google, Google Scholar, LIBRIS and DISA. Besides searching for literature by using the key words, you can also evaluate the references in the articles that you have already found, and select the articles related to your research question and purpose.
2.5.2 Interview
Interviews are commonly applied as the method of choice for researchers to use qualitative approaches in both psychology and sociology field (Potter and Hepburn, 2005; Robson, 2002).
Since the basic idea of this dissertation is to evaluate how the existing knowledge sharing and transfer practice used first, and then to focus on the improvements for better sharing and transfer mechanism. Especially for this kind of “how” “what” questions, interview is a suitable method to
get in-depth information with a focus group.
selection of interview type
The most commonly used division of interviews is structured interview, semi-structured interview and unstructured interview (Robson, 2002). As it is introduced in Colin Robson’s book Real World Research (Robson, 2002), the structure level is to some extent related to the ‘depth’ of feedback sought. Survey interview is an extreme example of highly structured interview. It has a list of ordered and standardized questions and responses to most questions should be chosen from the offered options. Structured interview has all the fixed questions with predetermined wording and order, and unstructured interview is totally informal with a general topic area (Robson, 2002).
Semi-structured interview was chosen to be employed in this dissertation. In semi-structured interview, interviewer has a checklist of topics and questions to be covered and there is a default wording or order for those questions (Robson, 2002). The expression and order may be changed because of each interviewee’s condition, such as some unplanned follow-up questions. So the way of semi-structured interview is flexible. It leaves a flexible space for interviewer to express all the concerning questions but still follow the main outline of the interview, and also gives the interviewees a comfortable and smooth environment to express themselves. Interviews can be carried out in different setting, such as face-to-face, telephone or e-mails. We decided to choose the face-to-face interview since expect to get more and in-depth information through the direction communication between interviewer and interviewee. And the interviews were in the form of one-to-one since there were 9 interviewees from different positions in the U-Care community.
issues need to think about before the interview
Interview is not that easy as expected, and there are still some issues that need to pay attention to before the interview. According to the interview experience in this dissertation, the main issues need to be considered are:
What tools are you going to use to tape the interview?
Where are you going to carry out the interview?
The tape can keep a permanent record and allow you to focus on the interview. The number of the records and the way that you plan to analyze the data can affect whether you could make a full transcript or not (Robson, 2002). We also considered using video to record each interview process, but it may influence the normal behavior of interviewee to communication with interviewer and some nervous mood may affect the feedback from interviewees, which may influence the final interview result to some extent. So we finally chose to tape the interview using recorder. We also prepared two recorders to make sure the safety of the data in case any one of them breaks down.
When choose the place to conduct the interviews, two points should be taken into consideration: is it convenient to the interviewees; is it quiet enough to carry out the interview. Considering all the interviewees are full-time workers, the interview time and place mainly depends on them. They were more likely to choose the places near their offices which is both convenient for the interview and their normal work. Whether the place is quiet or not is also very significant element. If there is
21 unnecessary noise, it will increase the difficulty index of transcribing tapes and analyzing the data.
How did we carry out interview
After decided to use interview for the empirical data collection, we followed these steps to carry out the interviews:
1. Organize the main questions based on the research question and the framework that used to investigate a digital community (shown in the Appendix);
2. Contact the coordinator to get permission for the interview by telling her our purpose and requirement for the interview. And ask for the cooperation regarding the selection of the respondents;
3. After getting the recommended name list for interviews, contact each person on the list to arrange each appointment and send the question list to them;
4. When carry out the interview, follow the recommended sequence from Colin Robson’s study (2002): Introduction, Warm-up, Main body of interview, Cool-off and Closure;
5. When record the whole interview, make some notes at the same time;
6. After each interview, fix some inappropriate places in the interview questions, such as inappropriate expression that interviewee cannot understand.
Advantages and disadvantages of interview
Interview is a flexible way of getting required information from the interviewees. Face-to-face allow the interviewer to modify his/her expression of enquiry and to give follow-up questions interested in that questionnaire or e-mail interview cannot achieve. And during the process of interview, interviewee’s body language and hesitation in the statement can also reveal some information regarding their opinion or attitude. But interview is time-consuming. Before the interview when make the preparation, it is necessary to make arrangement for each interviewee, to reschedule appointment according to each person’s condition, to confirm the presence, which takes a lot of time (Robson, 2002). In the actual interview session, it is also a skill to decide the length of the interview. If the interview is under half an hour, it seems that valuable information will be difficult to obtain. If the interview is over an hour, it will cause inconvenient for the busy interviewee. Remember that, the interviewer is the host of the interview, he/she is responsible for getting something from the interviewees but also closure it properly (Robson, 2002).
2.6 Selection of respondents
The focus group of this dissertation is the staff in the e-health community, so the range of selection of respondents for the interview is limited to the staff in the U-Care community which is the case investigated in this dissertation. Through the interview, the main purpose that we want to achieve is to get in-depth information regarding how the knowledge sharing and transfer practices are applied in the daily work between different departments in the community, what are the existing problems during the process of knowledge sharing and transfer. In order to get reasonable and reliable empirical data, the most important two characteristics of the selected respondents in this research are diversity in functional roles and diversity in levels of experience. The range of
respondents should cover different functional role from different departments and also both senior and junior workers in each department.
Before selecting the respondents, we contacted the coordinator of the community first in order to get the permission to conduct the interview among the staff and also to tell her our aim and requirements for the selected respondents. Soon we got the reply from the coordinator, and she not only gave us the permission for conducting the interview, but also the recommended name list which contains all the persons she considered suitable for taking the interviews. Then we contacted each person on the list to get permission and arrange schedule for each interview.
Finally, we got 9 interviewees which contain 1 coordinator, 3 psychologists, 2 health staff and 3 developers. The interview was conducted anonymously.
2.7 Transcription of the interview
As introduced in the book of Colin Robson (2002), three main approaches to qualitative analysis and interpretation contain: quasi-statistical approaches, thematic coding approaches and grounded theory approaches. For quasi-statistical approach, it depends on the conversion of qualitative data into the format of quantitative data. It is achieved by using word or phrase frequencies and relationship between them as the main method to reveal the relative importance and relationship of concepts and terms (Robson, 2002). For thematic coding approach, all the qualitative data are coded and labeled. Codes with same label are grouped together as a theme. Themes can be determined from relevance to research purposes or other theoretical considerations (Robson, 2002).
Themes and corresponding codes in each theme can be the foundation of further analysis and interpretation. Regarding grounded theory approach, it is the reverse of traditional model of research, in which research applies a theoretical framework to study a phenomenon. To some extent, it is a version of thematic coding approach, where qualitative data are coded according to researcher’s interpretation of the meanings in the text and related data are grouped into a theme.
This approach is used to develop a theory based on the data (Robson, 2002).
The approach used to qualitative data analysis in this paper is thematic coding approach. Themes are determined by the purpose of interview in the case study. The focuses predefined before the interviews are: the role of interviewee, interaction between roles, interaction with outside world, resources & constraints, activities and tools, acceptance for change, acceptance for technology boundaries and extra needs. So after the collection of interview data, they were coded and grouped into these themes, which helps to get clues for further analysis.
2.8 Reliability and validity of the research
In the qualitative researches, reliability and validity are two key factors to be addressed especially in the stage of data collection. Merriam (2002) stated “Reliability refers to the extent to which research findings can be replicated”. Interview is an appropriate instrument to obtain first-hand reaction and responses from the interviewees in their own words. So it can reflect the real thoughts of the interviewees and reality in the community. Before the interviews, we also studied a lot of
23 literature to understand the key concepts and theories to make expressions clear and concise. In order to get good interview outcomes, we applied a framework regarding investigating practices in digital communities to help us define the interview questions. Before conducting the interviews, the interview questions were sent to my supervisor first to check the questions.
Validity shows how much the research findings are accordant with reality (Merriam, 2002). It mainly depends on the participants in the interviews. So on the basis of interview, we chose 9 persons covering main functional roles in the U-CARE community, which contains both senior and junior person in each functional role, to help us to get as valid results as possible. This enables us to get different perspectives from different functional roles and experience levels.
Additionally, theoretical and empirical data are analyzed and discussed without any bias through entire dissertation. No matter the suggestion or conclusion are all presented without any bias.
Reliability and validity are two issues taken into consideration throughout the whole dissertation.
3. Literature review
This chapter provides a summary of literature review. In the dissertation, we aim to conclude a framework that can be used to identify the knowledge transfer and sharing practices in the context of e-health community, and furthering provide some suggestion what techniques and methods can enhance corresponding practices. Thus, in the first section some basic concepts and theories are provided. In the second section, a summary of existing knowledge transfer and sharing frameworks in previous literature is given. In the last section, we explain a framework that we chose to use in case study and introduce other three alternatives as well.
3.1 Concept and theories
3.1.1 Different types of knowledge
Knowledge is broadly categorized into tacit knowledge and explicit knowledge. Tacit knowledge is considered as the knowledge existing within the cognitive environment (e.g. human brain) which is not expressed by words (Gibbons et al., 2010; Smith, 2001). It is highly personal, subjective form of knowledge, informal and can be inferred from the people’s statements (Sternberg, 1999). Explicit knowledge is technical or academic information or data which are described exactly in formal words, such as manuals, facts and so on (Smith, 2001). Explicit knowledge can be obtained through formal education or systematic study.
Knowledge is an abstract concept. Knowledge may exist in different carriers according to the context. In health industry, the knowledge sources exist in the format of documents, knowledge warehouses/Marts, applications, best practices and discussions (Bose, 2003). According to Ranjit Bose’s study (2003), it lists the specific existence of knowledge in each format, as shown in the following table:
Documents Knowledge Warehouses/Marts
Applications Best Practices Discussion
Patient admission;
Billing & payment;
Health administration;
Medical research literature;
Drug references
Patient record;
Providers’ clinical log;
Medical procedures;
Hospital operations
Knowledge mining &
analysis –clinical, financial &
administrative;
Decision-support;
Quality assurance
Procedure & care management;
Disease diagnosis &
test;
Pharmacy, emergency
& nursing practice;
Claims processing
Cost reduction Fraud & abuse prevention;
Performance measurement;
Coordination of care
Table 3: Knowledge sources in health care (source: Bose, 2003)
In Elizabeth’s study, the author summarized the ways that tacit and explicit knowledge used in the workplace and evaluated them basically from ten categories.
25 Figure 3: Tacit and explicit knowledge in the workplace (source: Smith, 2001)
It is shown in the figure above that no matter tacit or explicit knowledge are both resource of value to apply and never lack of. According to Rnjit’s study, it asserts that organizations that make good use of their employee’s steadily increasing wealth of tacit and explicit knowledge resources to solve problems and make decisions have a big competitive advantage (Bose, 2003).
3.1.2 Key characteristics of knowledge transfer and sharing in health
care industry
In order to design and develop knowledge transfer and sharing activities in the e-health community, getting the basic knowledge of key characteristics regarding knowledge transfer and sharing can offer sound evidence and make use of previous research resources. In the journal of Pentland D. et al (2011), the authors reviewed thirty-three papers regarding knowledge transfer and exchange within the time period between January 1990 and September 2009. The authors pointed out solid research into the area of knowledge transfer and sharing in healthcare is limited and further of analysis and evaluation regarding the characteristics may benefit their practical application more in healthcare (Pentland D. et al, 2011). The following table provides a part of the summary from Pentland’s integrated review:
Author and study type Findings
Mitton et al. (2007)
Systematic review of 81 papers
“Successful knowledge transfer and sharing can be achieved at the individual, organizational and communications levels and factors related to time/timing. Key factors include: ongoing research practitioner collaboration built on trust and clear roles and responsibilities fostered by ongoing face-to-face communications;
healthcare organizations should build capacity to encourage readiness for change and foster collaborative research; research outcomes should be summarized with recommendations tailored and relevant to specific audiences and delivered whilst timely. The value of knowledge brokers to facilitate these is indicated.”
Fixsen et al. (2005)
Meta-syndissertation of 377 papers including 22 experimental studies
“Information dissemination methods alone (research literature, mailings and practice guidelines) are ineffective as is training as a stand-alone method.
Employing longer term multilevel approaches to implementation are more effective with evidence for the inclusion of: skill-based training; practice-based coaching;
practitioner performance evaluation; program evaluation; facilitative administrative practices; and methods for systems interventions.”
Best et al. (2008) Mixed-method review
“Key translational research and knowledge integration factors include: improved communications; collaborative research; support systems; funding and incentives;
and consideration of policy development and organizational change principles.”
Harrington et al. (2008) Synopsis
“Key enablers of knowledge translation identified as: early, ongoing and face-to-face involvement between knowledge users and researchers; incentivizing knowledge exchange activities; allowing adequate time for collaborations to become established; capacity building both for researchers and practitioners/policy-makers; use of effective and multifaceted dissemination strategies; and use of knowledge brokers to link researchers, research users and policy/decision makers.”
Harvey et al.(2002) Literature review and concept analysis (75 papers)
“The presence of a facilitator who provides face-to-face communication and uses a range of enabling techniques has some impact on changing clinical and organizational practice despite variable effect sizes and differing costs. It is difficult to isolate which aspects of the facilitation process or the facilitator role are more or less effective in influencing change.”
Conklin and Stolee (2008) Qualitative Study
“Large KT networks may enable the better communication and use of knowledge.
The organizational context afforded by Communities of Practice can support the flow of knowledge among participants and enables research evidence and expert opinion to be delivered; variable evidence for cited methods having a direct effect on the behaviors of caregivers.”
McWilliam et al. (2008) Mixed-method evaluation
“Facilitators at the organizational level include: geographic proximity;
remuneration of efforts; recognition for outcomes achieved; team working is generally seen as highly facilitative of KT; time to build trust important facilitator of KT and more attainable in smaller groups; individual practitioners respond to adequate remuneration for time/effort.”
Bowen and Martens (2005) Multi-method qualitative study
“Knowledge Translation approaches should include efforts to: create an environment of interest and openness to research (providing a setting for KT to occur in, including building trust and confidence between partners); provide opportunities for collaborative research; develop and use a shared vocabulary and conceptual base; facilitate an understanding of research findings; foster an
